May is designated as Mental Health Month, so there is no better time than now to review what I’ve learned while in Vancouver and Rome. First, though, I’d like to give some of my own perspective on the topic. As a person who loved physiology, it’s amazing to me that we separate mental health from physical health. There is no separation of any aspect of our bodies…. everything is totally interrelated. Just think of the reaction to stress (the Fight or Flight reaction). Our adrenals pump cortisol which diverts blood from our stomach to our muscles, so that we can fight the stressor, or if, for example, it’s a battle we can’t win, like fighting off a bear, we flee. Our senses are heightened, but normal body functions are on pause. This takes a complicated interdependence of senses (sight, smell, hearing), brain interpretation, and muscle response. We now know that ongoing stress, the bane of modern life, causes damage to our bodies, because we can’t reconcile the stress simply by running or fighting. If we did, we’d lose our job, abandon our car on the highway, or rob banks to pay our bills!Each part of our endocrine system (adrenals, pituitary, ovaries, etc.) feeds hormones into our bloodstream to set in motion the things of every day life that we take for granted…. growth, ovulation, pregnancy, moods, blood pressure, etc. What some of us don’t realize is that there is a biofeedback loop. None of these glands operate independently of the other. My point is that our physical bodies and mental health are not independent of each other. Too much stress and we can get depressed. Inability to fix something serious may lead to anxiety. These can lead to stress ulcers, substance abuse, etc.It’s unbelievable that when we can go to the moon (decades ago) and recreate life, but we still can’t communicate how our brain works and affects our life and health, and how our life and health affect our brain. For some reason, anything that has to do with chemical imbalance that results in mood disorders is something to be ashamed of. If we inherit diabetes, we are not made to feel guilty, but inherit bipolar disorder and we hide or are stigmatized. Just as genetics and food and exercise and stress and sleep can exacerbate diabetes symptoms, so can they affect our mood. We need to consider all of these factors when looking at mental health. There is, for example, literature that shows that light and exercise are extremely powerful in combating depression. We have yet to learn the impact of food, though we do know that carbohydrates can cause huge swings in insulin levels and, therefore, moods.I will spend most of this blog concentrating on some of what I’ve learned about bipolar disorder, but I would ask that each of us remember that balance of physical, emotional and spiritual aspects of our world are important for any part of our health. Bipolar disorder is one mental health challenge greatly impacted by habits, especially sleep. So when you are feeling sad, agitated, anxious, there are many things that can help bring your mind and body into balance…. massage, exercise, sleep, healthy foods, conversation. It’s all about realizing that your physical body and mental performance and mood are intimately connected.
What I learned in Vancouver
In Vancouver, at the University of British Columbia’s Collaborative RESearch Team to study psychosocial Issues in Bipolar Disorder (CREST.BD) program, 22 volunteers who were deemed to be creative and challenged by Bipolar Disorder (BD) attended a Community Consultation Day, with two optional evening programs dedicated to artistic expression (film and music). The volunteers met as a group for an introduction in the morning, then were broken into 4 focus groups. At the end of the day, they came together again for a review of the day. The predominant impression given by volunteers in focus groups was that they wanted to know that they weren’t alone. They specifically said that the day gave them “validation.” The people in this group were selected because of their creative nature, and many different kinds of creativity were represented. Few were musicians, not unexpected when they had to be there at 9 AM!Both in the groups and general discussion, the participants often were often emotional, expressing sadness, frustration, even anger about how they are treated by practitioners and people in general. Each one had their own individual story….. frequent problems with jobs, postpartum issues, social isolation, but they all agreed that they were hungry for the opportunity to meet with a group who understood and practitioners who respected them.The results of the focus groups have not been tabulated yet, so I can’t speak in specifics; however, one thing that everyone agreed on is that mania is not the state when they are most creatively productive. In some cases, people felt as though they had some intense insights that could only come from mania, but that they needed to be refined when in a more controlled state. Further, depression resulted in an inability to effect creative ideas. The best place for creativity is that “soft spot” between the two (euthymia), when there is a feeling of happiness and energy. This is a critical admission, as the noncompliance with medication is often contributed to the fear of loss of creativity that comes with mania. As I found out in Rome, the complications of mania alone are serious enough reason to avoid it. Nonetheless, an artist will often jeopardize himself or herself for the need to express themselves in their chosen art form. These findings suggest that it is not necessary, in fact, counterproductive.When the results of these two days are published, I will be sharing them with you. The two things I left with were: (1) there is a need to talk about bipolar disorder out in the open, and (2) the talent, beauty and creativity represented bring a wonderful dimension to life and our world, such that people were happy to be themselves and wouldn’t trade their creativity for the lack of BD. Both of these perspectives validate the mission of the Sean Costello Memorial Fund. Interestingly, I received personal thank yous from several people for starting the Fund and for introducing them to Sean.
Rome
The experience in Rome was much different than Vancouver. The International Review of Bipolar Disorders (IRBD) is an international conference on bipolar disorder with 1400+ attendees from around the world. (I met people from Britain, Syria, Iran, France, just to name a few.) Most of those in attendance were practitioners who work in treating or researching bipolar disorder. The crème de la crème of the bunch were the presenters. Among them were Sheri Johnson, Erin Michalak, Greg Murray and Eric Youngstrom of our advisory board, Eric presenting 3 different times. Given that the other presenters were researchers recognized for their knowledge of bipolar disorder and recent breakthroughs in treatment, the Sean Costello Memorial Fund was showcased in an amazing way. To me, it was both exciting and humbling.Unfortunately, it is impossible for one person to attend every session, and there were several times when I didn’t know which session to pick. For the ones I did, the attendance resulted in a huge auditorium plus balcony filled to overflow (I sat on the steps for one session!). The other down side was that slides were not handed out and many of the presenters spoke in broken English, so it was a mad rush to copy what was on screen, while trying to interpret what was being said JWhat was repeated over and over again was the term “bipolar spectrum.” It was suggested that bipolar disorder includes everything from Cyclothymia (with or without obvious symptoms) to Borderline Personality Disorder. Further, BD does not necessarily present itself alone, but with other comorbid anxiety disorders. The most common of these is Social Phobia, followed by OCD (Obsessive Compulsive Disorder) and Panic Disorder/Agoraphobia. OCD is found in about 55.8% of people who are bipolar. An important thing to note is that when social phobia is treated with antidepressants, it leads to hypomania[1], which, in effect, worsens the symptoms. It was even stated that if there is a first degree history of bipolar depression, one should not be prescribed antidepressants.Panic Disorder occurs in 15-37% of people who are bipolar. Panic disorder is more prevalent in families with an increased incidence of Bipolar Type II. [2] People with Panic Disorder tend to have ‘rapid cycling’ which is difficult to manage (people cycle quickly from depression to hypomania or mania.) The distinction between BD and Borderline Personality Disorder (BPD) is not clear, as cyclothymia[3] overlaps both.One thing that was described in detail was the Impulsivity in Bipolar Type II. The manifestations of this impulsivity are: substance abuse, increase in risky sexual behavior, aggressive behavior, impaired impulse control and self-stimulation via sensation seeking behavior (via work, sex, food, drugs, gambling, sports, internet, etc.). It was stated that BD Type II is 6x more prevalent than currently being diagnosed, with depression being the catch-all diagnosis. I was also told that most practitioners are not up to date on the diagnosis of BD, especially Type II, so it is important for the consumer to be educated about the symptoms; otherwise, there is a big chance for misdiagnosis and since the onset of treatment is directly related to outcome, this information is important.Future blogs will explore other topics and information about bipolar disorder. To be honest, some of the presentations were for practitioners with advanced knowledge and ended with more questions than answers. I think that the world of bipolar disorder is in the same place…. more questions than answers. Because the statistics suggest that a little more than 4 of every 100 people in the US are bipolar, and because the cost to society is almost immeasurable, the push for answers must continue. Hopefully, the SCMF will be an integral part of improving the outcomes of intervention by helping communicate the need for attention to this insidious and dangerous disease.I really wish to thank everyone who ever contributed to the Fund. Without you, we would not have been represented in Rome by our science team, nor would I have been able to attend the conference. The important part of my going was to reinforce my determination to keep moving forward with our mission. There is much to learn and communicate and even more to discover. Dissemination of this information is the first step to improving the lives of people who are challenged by this complex disorder. As the body is an integral whole, so is the universe. It is in each of our interests to help people who suffer with any mental illness feel accepted and hopeful. The creative talent represented by BD is even more reason for us to become educated and proactive. I think of Sean when I hear BD…. whomever you think of is a reason to participate in this worthy fight.Debbie Costello Smith
[1] Hypomania is a less severe form of mania. Hypomania is a mood that many don't perceive as a problem. It actually may feel pretty good. You have a greater sense of well-being and productivity. However, for someone with bipolar disorder, hypomania can evolve into mania -- or can switch into serious depression. (Web MD)
[2] Bipolar Disorder Type II is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes. (NIMH)
[3] Cyclothymia is a mild form of bipolar disorder in which a person has mood swings over a period of years that go from mild depression to euphoria and excitement (PubMedHealth)